Baseline Type 2 Biomarkers Can Predict Asthma Remission with Dupilumab, with Mario Castro, MD, MPH

Elevated baseline levels of biomarkers blood eosinophils (Eos) and fractional exhaled nitric oxide (FeNO) are indicative of a patient with moderate to severe asthma being more likely to achieve clinical remission with dupilumab (Dupixent), according to new research.

Analysis from the phase 3 QUEST trial and its extension TRAVERSE study — presented at the American College of Chest Physicians (CHEST) 2025 Annual Meeting in Chicago, IL, this week — showed a significantly higher likelihood of patients with moderate to severe asthma achieving remission though 52-week, 200/300 mg dupilumab add-on therapy when baseline Eos counts were ≥150 cells/mcL or higher. Among patients with baseline Eos counts of ≥500 cells/mcL, the likelihood of achieving remission with the biologic was more than four-fold greater than place (odds ratio [OR], 4.04; 95% CI, 2.45 – 6.68; P <.0001).

The team also observed a significantly higher likelihood of dupilumab-associated remission among patients with baseline FeNO levels ≥20 ppb (OR, 2.35; 95% CI, 1.74 – 3.16; P <.0001) or ≥50 ppb (OR, 2.26; 95% CI, 1.38 – 3.70; P <.01). For both biomarkers, instances of low baseline levels (Eos <150 cells/mcL; FeNO <20 ppb) were not associated with increased likelihood of clinical remission.

In an interview with HCPLive during CHEST 2025, study author Mario Castro, MD, MPH, Chief of the Division of Pulmonary, Critical Care and Sleep Medicine at University of Kansas Medical Center, emphasized that these findings should encourage his colleagues to seek out baseline measures of both FeNO and Eos before initiating care in a new moderate-to-severe asthma patient.

The problem is that panel is not necessarily prioritized by every clinician — and some struggle with patient follow-through on the test script. But these new data may help shape a persuasive argument.

“The one thing I do is I just briefly explain to the patient, ‘I want to get the right drug for you that’s going to work best for you. I need these blood tests and I need the [pulmonary function] test’,” Castro explained. “I tell them that just because then they understand the importance behind it, they appreciate it, and they appreciate you taking that extra effort to try to figure out what's the best medicine for them.”

The other take-home strategy is to follow guidelines recommending repeat biomarker tests up to 3 times per patient, Castro said — again, a task more easily said than done.

“There's variability in those biomarkers based on when you got your inhaled steroid last, so it's important for clinicians now to think about not just doing it once, but doing it multiple times,” he said.

References

1. Canonica WG, Pavord ID, Couillard S, Bruselle GG, et al. Baseline Type 2 Biomarkers as Predictors of Multicomponent Clinical Remission Following Dupilumab Treatment in Patients with Moderate-To-Severe Asthma. Poster presented at: CHEST Annual Meeting 2025. Chicago, IL. October 19 – 22, 2025.
2. Castro M, Corren J, Pavord ID, et al. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. N Engl J Med. 2018;378(26):2486-2496. doi:10.1056/NEJMoa1804092